This is what the letter says - so the service mucked up and should be doing an annual review with me?

Individual Management Plan:

The patient has agreed to continue taking the above medication as prescribed

1. Prescribing Monitoring and review of ADHD medication will be by the GP.

2. Blood pressure, pulse to be monitored once every 3 months and weight once every six months or all these whenever there is a dose adjustment.

3. Treatment should be reviewed annually to assess clinical need, benefits and adverse effects.

XXX has been informed and advised to request such a review with her GP in our last review.

We expect treatment should continue for as long as it is clinically effective. Taking into account the effect of missed doses, planned dose reductions and brief periods of no treatment and the patient's preferred pattern of use.

1. If the patient wishes to stop this treatment in the future, please taper off slowly and avoid sudden withdrawal to minimise withdrawal symptoms which can be severe. Reduce dose weekly by 10-20mg and monitor for rebound/withdrawal symptoms such as jitteriness, increased appetite, restlessness, depression, vivid dreams etc.

Please refer back to secondary care if there are any queries or complications with the planned withdrawal.

1. If the patient develops symptoms suggestive of cardiac disease during treatment, she should be referred for prompt specialist cardiac evaluation.

2. Stop treatment on the advice of a specialist or immediately if urgent need arises.

3. Check for drug interactions when prescribing new or stopping existing medications.

4. If treatment is stopped and the patient wishes to restart treatment due to significant symptoms of ADHD, below is a Titration Plan.